Insurance is no guarantee of mental health care, study finds

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Mental health care in the U.S. remains difficult to access, even in major U.S. cities and even as insurance options expand, a new study says.

Posing as patients, investigators in the study tried to get appointments with 360 outpatient psychiatrists based in Boston, Houston and Chicago. What they found was that more than half of the first phone call attempts went unanswered or went to incorrect phone numbers, according to HealthDay.

Unanswered calls were returned a little more than a third of the time. Follow-up calls by investigators didn’t prove much more effective, HealthDay reports, as proof of insurance or willingness to pay out of pocket only secured appointments with one quarter of the doctors contacted.

The study’s lead author, Dr. J. Wesley Boyd, an assistant clinical professor in the department of psychiatry at Harvard Medical School, told HealthDay “one message from this is that having insurance, even good insurance, is not enough to guarantee you can get the mental health care you need.”

The study was published in the journal Psychiatry Services. It follows a 2011 study conducted by Dr. Boyd in which a team of Harvard researchers posed as severely depressed patients with good health insurance and tried to get psychiatric care at 64 facilities in downtown Boston. WBUR reports that researchers in the study were only able to get eight appointments, and only four of those were within two weeks.

According to statistics from The National Institutes of Mental Health, 19 percent of Americans over the age of 18 experienced a mental, behavioral or emotional disorder (not including substance abuse or developmental disorders) in 2012, and 4 percent suffered from a severe mental illness. The National Alliance on Mental Health reports that almost 60 percent of adults with a mental illness received no mental health services in the previous year.

One of the major roadblocks for those seeking mental health care has been lack of coverage by insurers. The New York Times reports that the Affordable Care Act will vastly expand mental health coverage by providing access for millions of Americans who were previously uninsured. The ACA greatly extends the reach of the 2008 Mental Health Parity and Addiction Act, writes Kaiser Health News. That legislation required insurers to provide the same type of coverage for mental illness and substance abuse treatment as they would for physical ailments.

But the study shows that even with health insurance, getting help isn’t easy. "It's all the more poignant for those who are profoundly depressed or anxious, because for them it may really be just too much to be able to make enough phone calls and endure all the hurdles in their way before actually being able to secure an appointment," Dr. Boyd told HealthDay.

Dr. Boyd also said he believes that part of the problem is that there aren’t enough psychiatrists to handle the demand. According to the American Psychiatric Association, there are 50,000 psychiatrists in the United States, a number that is too small to serve the patients who need help.

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